The resident doctors are gagged mules. They are made to sign illegal confidentiality agreements not to disclose the atrocities happening in these teaching hospitals.
In any other profession, where negligence leads easily to death, there would be an inquiry. The inquiry would lead to stiffer protective regulations. But a doctor has died, his grieving colleagues are lamenting, and his bosses are running around like excited apprentice masquerades seeking to disconnect any link between that tragedy and the mind-bending schedules resident doctors endure in teaching hospitals.
They are gagged donkeys.
A few days ago, a house officer slumped in church and died. The immediate cause of death hasn't been established but a well-dispersed anonymous letter sent alarm bells ringing. The letter said Dr Michael Umoh was worked to death. Embarrassed by the letter, the hospital jumped into crisis management mode to deny culpability and whitewash a sepulchre. It said the man didn't do a 72-hour call and didn't slump in the hospital. That's true. Deftly, the senior doctors painted a rosy picture of that hospital. The management didn't bother to tell the public that junior doctors in that hospital were being overworked. But somewhere in that denial, someone said that Umoh had a 48-hour straight call two days before he died. The truly pathetic bit was the local Association of Resident Doctors (ARD) struggling slavishly to defend the integrity of the hospital and portray it as resident doctor-friendly.
The truth is that chickens will always come home to roost. Teaching hospitals can't find residents. Young doctors have lost faith in the system. The brunt of the crumbling artifice must now be borne by the unfortunate few who decide to train in the country. The senior doctors are tragically aloof. They sit astride and overload the residents with unbearable schedules. A resident finishes a 24-hour call and resumes work at 8 a.m. the next day. She might not have slept at all. She begins to see patients immediately and sees them till night. Then she rushes home through the maze of traffic. Many teaching hospitals have no staff quarters. She gets home at 11 p.m. and can hardly see her children. Then she is up at 5 a.m., jaded and hurrying like a zombie. Work starts at 7.30 am.
Because resident doctors are few, she sees three times the volume of patients she is supposed to see. She is used the same way the smugglers at Seme use those 'fire wall' vehicles. Expanded to carry thrice their capacities. Driven at mad speeds. Used without sympathy. When work ends, she starts another call because she is on an alternate-day call. That is the roster. Her appetite is low, her taste buds are flat. Her head aches. Yet, the call duty rooms are shabby, and the toilet facilities are messy. So her anxiety has no remissions. On that call, she might not sleep a wink. Yet in the morning, she resumes another day's job at 8 a.m. Three days have passed, and she hasn't taken a breath. A beast of burden. And this unforgiving cycle of torture continues.
If she dies in church one weekend, the senior doctors in the hospital will gather journalists to tell them how the hospital is run professionally. And the local ARD Chairman, perhaps a puppyish lackey of the management, will corroborate the story that the hospital takes very good care of its resident doctors.
The resident doctors are gagged mules. They are made to sign illegal confidentiality agreements not to disclose the atrocities happening in these teaching hospitals. Because they are apprentices who must remain in the good books of their masters to earn their freedoms and progress in their careers, they submit to 'suffering and smiling'. The hospitals are poorly staffed and wretchedly equipped...
The resident doctors are gagged mules. They are made to sign illegal confidentiality agreements not to disclose the atrocities happening in these teaching hospitals. Because they are apprentices who must remain in the good books of their masters to earn their freedoms and progress in their careers, they submit to 'suffering and smiling'. The hospitals are poorly staffed and wretchedly equipped and the senior doctors who are the regulators of the medical profession sabotage the system by refusing to take definitive corrective measures.
The senior doctors aren't just aloof. When the hospitals are visited for accreditation, senior doctors hide the true picture. They borrow instruments and cook data. The auditors are fooled. Senior professionals shouldn't cut corners like common exam cheats. When senior doctors conspire to pull wool over the eyes of accreditors, they deny the sick system a cure. A hospital that should be concerned with maintaining its oversized status then reaches out brazenly for a higher recognition in grandiose sub-speciality ambitions. The junior doctors can't speak out. Anyone who tells the truth is victimised by the senior doctors, who constitute the hospital management, and who think their priority is to defend a rotten system.
Resident doctors teach nursing mothers to be baby-friendly. They teach good sleep and relaxed work schedules. They teach conscious attention to the health of the mind and body. They help patients to understand the association between prolonged psychological stress and chronic diseases. However, female resident doctors are made to forgo their families in the name of residency training. The tragedy goes beyond damage to health and family bonds. Most resident doctors, who are reared like Zungeru cattle, have no time to read. So, rather than become medical scientists, they become medical mechanics. Burnt out by chores and reduced to servitude by hellish schedules, they lose their imagination.
Some senior doctors like to tell fables about how they were trained by being overloaded with schedules and cases. They don't remember to say that, those days, residents went home, and took a day off, after a call. They don't mention that some of them got brand new cars on graduation and the call rooms weren't shared shabby hostels with bunk beds as you see in some big teaching hospitals masquerading as centres of excellence. Those days, call rooms dignified doctors and doctors on call got good food. They don't tell that teaching hospitals had good labs and blood banks, and everything was done within, and residents didn't have to chase patients around to buy syringes and gloves because the hospitals had them.
Senior doctors must stand "hippocratically" rather than hypocritically. Senior doctors run public hospitals. Senior doctors also accredit public hospitals and regulate medical training. They should define and enforce minimum standards. If there are no resident doctors, then some wards must be shut. That is better than working the existing residents to bruised heart valves and calloused arteries and normalising shambolic medical care.
In any other profession, where negligence leads easily to death, there would be an inquiry. The inquiry would lead to stiffer protective regulations. But a doctor has died, his grieving colleagues are lamenting, and his bosses are running around like excited apprentice masquerades seeking to disconnect any link between that tragedy and the mind-bending schedules resident doctors endure in teaching hospitals. The Igbo will advise that the hand of the monkey be removed from the soup if the suspicion of cannibalism is to be avoided.
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So what's the remedy? It's simple. Senior doctors must stand "hippocratically" rather than hypocritically. Senior doctors run public hospitals. Senior doctors also accredit public hospitals and regulate medical training. They should define and enforce minimum standards. If there are no resident doctors, then some wards must be shut. That is better than working the existing residents to bruised heart valves and calloused arteries and normalising shambolic medical care. Hospitals must be reassessed periodically.
Because some senior doctors cheat and undermine these exercises, some of these assessments must happen discreetly. Hospitals that can't meet accreditation requirements must be pruned or downgraded. The senior doctors who run public hospitals take oaths to protect young doctors and defend the integrity of medical care. They are derelict in their duties when they close their eyes and allow the hospitals to become shabby workhouses. It's difficult to ascertain whether it's selfishness or cowardice. But they can't continue propping up the farce. When large hospitals begin to lose accreditation, the politicians will sit up and fund the institutions and slow the brain drain.
Propaganda can only buy time. Our chickens will surely come home to roost.
Ugoji Egbujo writes from Lagos.
